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Diagnosing Coeliac Disease Updated 2021
Understanding Coeliac Disease
Coeliac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. It affects approximately 1 in 100 people in the UK, although many remain undiagnosed. The only current treatment is a strict, lifelong gluten-free diet.
Recognising Symptoms
Symptoms of coeliac disease can vary widely among individuals and can affect any area of the body. Common symptoms include gastrointestinal problems such as diarrhoea, abdominal pain, and bloating. Non-gastrointestinal symptoms may include fatigue, anaemia, osteoporosis, and skin rashes. Because of this variability, coeliac disease can often be misdiagnosed or remain undiagnosed for years.
Initial Screening: Blood Tests
The first step in diagnosing coeliac disease typically involves blood tests that check for specific antibodies. The most common tests include:
- Tissue transglutaminase antibodies (tTG-IgA)
- Endomysial antibodies (EMA-IgA)
- Deamidated gliadin peptide antibodies (DGP-IgA and DGP-IgG)
It's important to note that patients should continue consuming gluten while these tests are conducted to avoid false-negative results. If these blood tests suggest coeliac disease, further diagnostic steps are recommended.
Confirmatory Diagnosis: Biopsy
If initial blood tests are positive, the next step is typically an endoscopic biopsy of the small intestine, conducted by a gastroenterologist. During this procedure, small tissue samples are taken from the lining of the small intestine to look for damage to the villi, which are the small, finger-like projections that absorb nutrients. If villous atrophy is observed, a diagnosis of coeliac disease is confirmed.
Genetic Testing
Genetic testing for HLA-DQ2 and HLA-DQ8 genes can support the diagnosis, although it is not definitive, as these genes are present in about 30% of the UK population. However, a negative result for these genes can effectively exclude coeliac disease as a diagnosis.
Post-Diagnosis: Management and Follow-Up
Once diagnosed, patients must adhere to a strict gluten-free diet, eliminating all sources of wheat, barley, and rye. Follow-up care is crucial to monitor the patient’s response to the diet, usually involving periodic blood tests to check for nutrient deficiencies and whether the coeliac-specific antibodies have returned to normal levels.
Conclusion
Early and accurate diagnosis of coeliac disease is essential to prevent long-term health complications. If you suspect you have coeliac disease, consult your GP who can guide you through the necessary diagnostic procedures. Awareness and understanding of coeliac disease have significantly improved in the UK, contributing to better patient outcomes.
Frequently Asked Questions
What is coeliac disease?
Coeliac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine.
What are the symptoms of coeliac disease?
Common symptoms include diarrhoea, abdominal pain, bloating, and nutritional deficiencies, among others. Some individuals may also experience joint pain and fatigue.
How is coeliac disease diagnosed?
Diagnosis typically involves blood tests to check for specific antibodies and a biopsy of the small intestine to assess any damage to the villi.
What blood tests are used to diagnose coeliac disease?
The most common blood tests are tissue transglutaminase antibodies (tTG-IgA) and endomysial antibodies (EMA).
Does a patient need to be eating gluten before testing for coeliac disease?
Yes, it is crucial to continue eating gluten-containing foods before the testing to ensure accurate results.
Can coeliac disease develop at any age?
Yes, coeliac disease can develop at any age, from infancy to adulthood.
What happens if coeliac disease is left untreated?
Untreated coeliac disease can lead to serious health complications, including osteoporosis, infertility, neurological conditions, and an increased risk of some cancers.
Is there a cure for coeliac disease?
There is no cure for coeliac disease, but it can be effectively managed with a strict, lifelong gluten-free diet.
What foods should be avoided by someone with coeliac disease?
Foods containing wheat, barley, and rye should be avoided. This includes bread, pasta, cereals, and many processed foods unless specifically labeled as gluten-free.
Can oats be included in a gluten-free diet for coeliac disease?
Pure, uncontaminated oats can be consumed by many people with coeliac disease, but they should be introduced cautiously and under medical supervision.
How long does it take to feel better after starting a gluten-free diet?
Many people start to feel better within a few weeks, but complete healing of the intestine may take several months to years.
Is coeliac disease hereditary?
Yes, coeliac disease has a genetic component, and first-degree relatives of a person with coeliac disease have a higher risk of developing the condition.
Are there any medications for coeliac disease?
Currently, there are no medications available to treat coeliac disease. The primary treatment is a strict gluten-free diet.
How can I avoid cross-contamination with gluten?
Avoid cross-contamination by using separate cooking utensils, toasters, and food storage containers. Also, ensure thorough cleaning of kitchen surfaces and hands.
Where can I find support for living with coeliac disease?
Support can be found through coeliac disease patient groups, such as Coeliac UK, which provide resources, advice, and emotional support.
Useful Links
Useful links from: Coeliac Disease Explained - Gluten Sensitivity - A to Z of the NHS - Dr Gill
- NHS - Coeliac Disease Comprehensive information from the NHS about coeliac disease, including symptoms, causes, diagnosis, treatment, and guidance on living with the condition.
- Coeliac UK The UK's leading charity for people with coeliac disease, providing support, resources, and advocacy for those affected by gluten-related disorders.
- NHS - Gluten Sensitivity Information from the NHS on gluten sensitivity, including symptoms, diagnosis, and management of non-coeliac gluten sensitivity.
- Guts UK A charity focusing on digestive health, offering information and support on various gut issues, including coeliac disease and gluten sensitivity.
Useful links from: Coeliac Disease: Session 1: What is Coeliac Disease?
- NHS - Coeliac disease Official NHS page on Coeliac disease, explaining what it is, symptoms, causes, diagnosis, and treatment options available.
- Coeliac UK - What is Coeliac disease? Comprehensive information from Coeliac UK, a leading charity, on what Coeliac disease is, including symptoms, diagnosis, and managing the condition.
- Coeliac UK - Newly diagnosed Dedicated section by Coeliac UK for those newly diagnosed with Coeliac disease, offering guidance and support for understanding and managing the condition.
- NHS Inform - Coeliac disease A reliable resource from NHS Inform providing detailed information on Coeliac disease, including symptoms, diagnosis, and how to live with the disease.
Useful links from: Living Well with Coeliac Disease
- NHS - Coeliac disease Overview of coeliac disease including symptoms, causes, diagnosis, treatment, and living with the condition from the National Health Service (NHS).
- Coeliac UK - Living with Coeliac Disease Comprehensive resource on living with coeliac disease provided by Coeliac UK, the charity dedicated to supporting those with the condition and their families.
- NHS - Coeliac disease: Foods to avoid Advice on foods to avoid with coeliac disease and substitutes that are available, from the NHS.
- Coeliac UK - Gluten-Free Diet Information on maintaining a gluten-free diet and lifestyle from Coeliac UK, including guidance on food labeling and eating out.
Useful links from: Coeliac disease
- NHS - Coeliac Disease The NHS page on Coeliac Disease provides comprehensive information about symptoms, diagnosis, treatment, and living with the condition.
- Coeliac UK Coeliac UK is a charity that offers support, information, and resources for those affected by coeliac disease. Their website features guides on gluten-free living, research updates, and membership benefits.
- NHS - Gluten-Free Diet This NHS page provides detailed information about gluten-free diets, including tips for managing coeliac disease through dietary changes and ensuring nutritional balance.
- Gluten Free Food Trust The Gluten Free Food Trust is a UK-based charity dedicated to advocating for those with coeliac disease. They offer information on finding safe foods, navigating social situations, and the latest on gluten-free research.
Useful links from: Causes of coeliac disease
- NHS - Coeliac disease Provides information on the causes of coeliac disease, including genetic factors and how the immune system reacts to gluten.
- Coeliac UK - What causes coeliac disease? Explains the factors that may contribute to the development of coeliac disease, focusing on genetic predisposition and environmental triggers.
- NHS Inform - Coeliac Disease Offers comprehensive details on coeliac disease, including causes, symptoms, diagnosis, and treatment options.
- Coeliac UK - Coeliac Disease: Symptoms and Diagnosis Provides information on the various symptoms of coeliac disease and how it is diagnosed, as well as factors that can aggravate the condition.
Useful links from: NHSGGC - What is Coeliac Disease?
- NHS - Coeliac disease Comprehensive guide on coeliac disease provided by the NHS, covering symptoms, diagnosis, treatment, and living with the condition.
- Coeliac UK - What is coeliac disease? Detailed information about coeliac disease from Coeliac UK, a leading charity for people with the condition. Includes resources for diagnosis, diet, and support.
- Gluten Free Society UK - Coeliac disease Resources and support provided by the Gluten Free Society UK, focusing on the causes, symptoms, and management of coeliac disease.
- British Dietetic Association - Coeliac disease Professional guidance from the British Dietetic Association on managing coeliac disease, including dietary advice and nutritional information.
Useful links from: Symptoms of coeliac disease
- NHS - Coeliac disease Comprehensive information from the NHS on coeliac disease, its symptoms, diagnosis, treatment, and management.
- Coeliac UK - Symptoms of coeliac disease Coeliac UK provides detailed insights into the various symptoms of coeliac disease, including digestive and non-digestive symptoms.
- NHS Inform - Coeliac Disease NHS Inform offers a thorough overview of coeliac disease, focusing on symptoms, causes, diagnosis, and treatment options.
- Coeliac UK - Living with coeliac disease This page from Coeliac UK provides support and information for people living with coeliac disease, including dietary advice and symptom management.
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